Disturbances of circadian profile and blood pressure control in patients with systemic lupus erythematosus without overt heart disease.

Introduction: Lupus erythematosus (SLE) is an autoimmune disease that causes a significantly increased risk of cardiovascular diseases. This process is underlain by the early and accelerated atherosclerosis. Aim: To assess the diurnal blood pressure profile disturbances in normotensive patients without overt cardiovascular disease and to correlate with early atherosclerotic markers. Material and methods: The study included 32 baseline normotensive women with SLE and 30 healthy control women. Each participant underwent a 24-hour automatic blood pressure measurement and an ultrasound assessment of intima media thickness (IMT) and the presence of carotid atherosclerotic plaques. Results: Atherosclerotic plaques were present in 46.9% of SLE women. They had a significantly higher IMT compared to those without atherosclerotic plaques and control group (0.833 ±0.216 vs. 0.606 ±0.121 vs. 0.66 ±0.16 mm). A significant positive correlation was found between IMT and age of patients, nocturnal systolic blood pressure (SBP), nocturnal systolic pressure (SP) load, nocturnal SBP decline and presence of atherosclerotic plaques. The plaques positively correlated with age and with ambulatory blood pressure monitoring (ABPM) parameters. Fifty percent of SLE women had an abnormal 24-hour BP profile, of which 4 had non-dipper, 8 invers, and 4 hyper-dipper profile. Based on ABPM, hypertension can be diagnosed in 14 (43.75%) initially normotensive women. Women with SLE and arterial hypertension (HA) had atherosclerotic plaques significantly more often, especially in nocturnal hypertension. Conclusions: The authors confirm the underestimation of hypertension in SLE. Most women diagnosed with hypertension by ABPM had nocturnal hypertension. We showed a more frequent disturbed BP and a significant relationship between the abnormal BP profile, especially nocturnal hypertension, and accelerated development of atherosclerosis.

Abnormalities of heart rate turbulence and heart rate variability as indicators of increased cardiovascular risk in patients with systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is a connective tissue disease manifested by progressive fibrosis of many internal organs including the cardiovascular system and development of autonomic disorders with sympathetic predominance. These abnormalities can increase cardiovascular mortality. AIM: To evaluate heart rate turbulence (HRT) and variability (HRV) parameters (indicator of autonomic imbalance) obtained from 24-hour ECG Holter monitoring, as predictors of the increased cardiovascular risk in patients with scleroderma. MATERIAL AND METHODS: Thirty-twoscleroderma patients and 30 healthy people were included. After clinical examination, ECG, routine laboratory tests and echocardiography, participants performed 24-hour Holter-ECG at home. For HRT assessment, turbulence onset (To) and turbulence slope (Ts) parameters were used. Both time and frequency domain analysis of HRV was used. The HRV circadian rhythm was also evaluated. RESULTS: Time domain: SDNN, SDNN-ix, SDANN and frequency domain: LF, VLF, ULF, NHF, NLF, parameters were lower, while p50NN was higher in SSc as compared to the control group. There was also a loss of the circadian rhythm for r-MSSD and p50NN present in the control group. Abnormal HRT parameters To and/or Ts occurred in the SSc group only. The median value of To = -1.24% and Ts = 11.13 ms/RR did not differ significantly as compared to the control group. CONCLUSIONS: The study confirmed the presence of HRV disturbances, including HRV circadian rhythm, as it may seem at an early stage of SSc. The HRT disorders may be characterized by the increasing changes with advancing disease. This indicates the presence of autonomic imbalance and an increased cardiovascular risk.

Non-sustained ventricular tachycardia during treatment of genotype 3 chronic hepatitis C - a case report.

UNLABELLED: More than 185 million people around the world have been infected with the hepatitis C virus (HCV), of whom 350 000 die each year. HCV is a now a curable disease, and advances in HCV therapy have resulted in steadily higher cure rates. Therapies based on PegINF are still treatment of choice. However PegINF can induce severe adverse events including cardiovascular disease. CASE REPORT: Here we report a 55 year old female patient with the severe hepatitis C and genotype 3 presented with recurring episodes of the loss of consciousness and palpitations in the course of therapy, combining interferon PegINF with ribavirin. During the diagnostics performed the occurrence of non-sustained ventricular. There were no other causes of arrhythmias, such as coronary heart disease or heart failure. It is considered that this is a result of treatment. Because of the confirmed viral clearance completed PegINF therapy at a lower dose, without further complications. CONCLUSIONS: The presented case of our patient illustrates very well the level of difficulty of the taken decisions, especially when treatment complications occurred, while also confirming the fairly assistive and supportive role of the non-invasive methods of cardiovascular diagnostics.

Cardiovascular risk assessment by electrocardiographic Holter monitoring in patients with chronic hepatitis C.

INTRODUCTION: Cardiovascular diseases are ranked as the third cause of mortality among people infected with hepatitis C virus (HCV), but the relationship of infection with cardiovascular risk remains disputable. We have focused on the comprehensive use of parameters obtainable during long-term electrocardiographic (ECG) Holter monitoring. MATERIAL AND METHODS: Heart rate variability and turbulence (HRV and HRT), deceleration/acceleration capacity (DC/AC), corrected QT interval (QTc) and late potential (LP) were used. 36 persons were included, and 30 healthy subjects formed a control group. All were submitted to 24-hour Holter ECG-monitoring. RESULTS: The studied groups were not statistically significantly different with regards to basic anthropometric parameters. Statistically significantly higher medium and maximum heart rhythm and aminotransferase activities were recorded in patients with hepatitis C. The HRV parameters r-MSSD, p50NN, HF, and absolute DC/AC values were significantly lower in the subjects with hepatitis C than those in the control group. The QTc interval, measured for nocturnal hours, was also significantly longer in that group. There were no differences in the albumin level or basic echocardiographic parameters, including left ventricle ejection fraction. Nor was there any difference in the HRT parameters, or LP. The most interesting observation was the positive correlation among the number of viral RNA copies and DC, and LF. CONCLUSIONS: We confirmed the presence of autonomic disorders with prevalence of sympathetic system activity and prolonged QTc interval in patients with chronic hepatitis C. Those parameters significantly correlated with infection intensity. Our results suggest that HCV infection could be an independent cardiovascular risk factor, not associated with the lipid profile. Further prospective studies are needed.

Serum NGAL, KIM-1, IL-18, L-FABP: new biomarkers in the diagnostics of acute kidney injury (AKI) following invasive cardiology procedures.

PURPOSE: The aim of this study was to assess the levels of selected markers in patients who underwent planned or emergency coronary angiography and to examine if they correlated with the occurrence of AKI. METHODS: The study included 52 patients who underwent planned or emergency coronary angiography and received contrast agent. Serum levels of markers (NGAL, L-FABP, KIM-1, IL-18) were analyzed in all patients using ELISA tests, at baseline, after 24 and 72 h from angiography. RESULTS: 9.62% of patients developed CI-AKI. No significant differences were observed between markers levels in patients who developed CI-AKI and those who did not. After 24 h, serum levels of IL-18 were higher in patients with CI-AKI, however, this difference was on the verge of significance. Increase in serum NGAL, KIM-1 and IL-18 was observed after 24 h. Serum levels of biomarkers were insignificantly higher in group with CI-AKI. Significant changes in levels in time (baseline vs. 24 h vs. 72 h) were observed only for NGAL [157.9 (92.4-221.0) vs. 201.8 (156.5-299.9) vs. 118.5 (73.4-198.7); p < 0.0001]. No significant correlations were observed between the decrease in eGFR or the increase in creatinine and biomarkers level. CONCLUSION: Obtained results do not allow for the indication of efficient AKI biomarkers. Their further validation in large studies of CI-AKI patients is required.

Effect of short­term testosterone replacement therapy on heart rate variability in men with hypoandrogen­metabolic syndrome.

INTRODUCTION:  Testosterone deficiency syndrome (TDS) is characterized by clinical signs of testosterone deficiency in men with reduced testosterone levels. It leads to endothelial dysfunction, which, apart from erectile dysfunction, accelerates atherosclerosis progression. OBJECTIVES:  The aim of the study was to evaluate the effect of testosterone supplementation in men with metabolic syndrome (MS) and TDS on autonomic balance assessed by heart rate variability (HRV) in 24­hour Holter monitoring. PATIENTS AND METHODS:  The study included 80 men divided into 3 groups: with MS and TDS (MS+TDS+, n = 30), with MS and without TDS (MS+TDS-, n = 25), and healthy controls (n = 25). The MS+TDS+ group received intramuscular testosterone therapy (Omnadren 250) for 9 weeks. Holter monitoring was performed in all patients at baseline and at the end of the therapy.  RESULTS:  Almost all HRV parameters were significantly lower in the MS+TDS+ group compared with controls. Moreover, total power (TP) as well as high- and low­frequency domains (HF and LF, respectively) were significantly lower in the MS+TDS+ group compared with the MS+TDS- group. There were significant differences in the standard deviation (SD) of normal-to-normal (NN) intervals (SDNN), SDNN index (SDNNI), and SDANN (SD of the averages of NN intervals in all 5­minute segments) as well as in ultra­low­frequency (ULF) domain between the MS+TDS- group and controls. Testosterone supplementation resulted in a statistically significant increase in SDNN, SDANN, TP, LF, ULF, and very­low­frequency domain. However, the values did not reach those observed in the control group. The levels of total and free testosterone were not significantly affected by the treatment.  CONCLUSIONS:  A 9­week testosterone supplementation therapy improves HRV parameters. Although these parameters did not reach the values observed in healthy men, the therapy may reduce cardiovascular risk in men with MS and TDS.

Recurrent syncope and hypocalcaemic cardiomyopathy as manifestations of Fahr's syndrome.

In our report we would like to present a case of a 60-year-old patient with epileptic seizures, affective disturbances, only mild neurocognitive disorders and cardiomyopathy. A female patient was taken to the internal ward with a tentative diagnosis of recurrent syncope. Laboratory results disclosed severe hypocalcaemia, hypoparathyroidism, and hypothyroidism. An echocardiogram revealed left ventricle systolic dysfunction. Computed tomography revealed massive intracranial calcifications typical for Fahr's syndrome. Our patient demonstrated only mild neurological and psychiatric symptoms, but developed hypocalcaemic heart failure. It is possible that some cases of Fahr's syndrome remain undiscovered, particularly patients taken to internal wards with mild neurological or psychiatric signs.